Sorry seems to be the hardest word

I like ‘mavericks’…people who don’t go along with accepted wisdom, because they’ve done their own homework and educated themselves with facts. Dr Malcolm Kendrick, a Scottish GP, is one of those. I don’t know how I first found his blog, but I’ve since bought his two books…The Great Cholesterol Con and Doctoring Data. I started reading the second one only last evening. His cynical humour makes reading it worthwhile for that alone. Laughter is the best medicine, as they say.

I’m becoming more and more fed up with the medical profession and the way they seem to do only what Big Pharma tells them. I go for a consultation, my GP takes my blood pressure, then spends the rest of my allocated 10 minutes looking at his computer screen. Finally he presses the print button and I am handed a prescription for some drug or other. I have never been asked about my lifestyle…what I eat, how much exercise I get, etc, etc. Holistic medicine went out the door years ago and reductionist medicine took its place. I believe more than ever, ‘you are what you eat’, not what someone tells you you should eat.

So anyway, the US dietary guidelines are about to be revised according to Dr K. Cholesterol, saturated fat and sodium (salt) are no longer ‘nutrients of concern’. Sugar is the killer. Didn’t we already know that?

So prepare yourself a satisfying plate of tasty, fried bacon and sit down and read the good doctor’s blog.

I think that the four words ‘I told you so’ should only be thought, and never written down. No-one likes a smart arse. But sometimes it is impossible to resist….just impossible. In this case I have failed. ‘Father forgive me, for I am weak.’ So, here goes…’I told you so.’

Some of you may be aware that the US dietary guidelines are going to be changed. For some reason it is required that the full report is suppressed for about a year. Presumably so that everyone can pile high their defences when the attacks begin. ‘I think you will find that I have always, ahem, supported these ideas.’ Cough, shuffle of papers….cough. ‘Sorry, no time to take questions.’ Exit left.

The entire report, I believe, stretches to about a bazillion pages. However, here are four of the highlights.

7 Responses to “Sorry seems to be the hardest word”

While I totally agree that modern medicine is often pill pushing, I’m dubious about a lot of what was written in this article.
The current fad of high saturated fat (I’ll get to salt in a second) diets, particularly the paleo diet incarnation, is loving anything that can be interpreted as saturated fat is ok. In my mind, and having over 10 years of working as a dietitian which this is based on, the low fat message is the biggest public health balls up of recent decades. This came from the major epidemiological studies showing that populations with a high fat diet, particularly high saturated fat diets, had high rates of heart disease. Thus the message was not just low saturated fat, but low total fat. The food industry jumped on board with highly refined carbohydrate, but low fat products which every one felt were healthy, so they are lots of them, while we ate larger portions in general and did a lot less activity, so the population became more and more overweight. The resaarch in dietary fats over the last decade, particularly the last 5 years has pretty conclusively shown that plant based mono and polyunsaturated fats are cardio protective (moreso poly, but they are both good) while refined carbohydrate is equally as bad for us as saturated fat. So the interpretation of the research is that saturated fat isn’t that bad. But there is no evidence anywhere showing that any type of saturated fat, including coconut, is protective. But there is great evidence for extra virgin olive oil and nuts. Why is that message never in the blogs? Because it isn’t as marketable and attention grabbing as “they were wrong all along.” There is some early stage evidence that saturated fats in fermented dairy (mainly yoghurt and cheese) are not as bad for us as saturated fats in animal foods, but this is early stuff and you can’t really make guidelines at a population level yet. More research is needed.
Salt is still an issue. Yes there are studies showing that a very low salt intake is associated with increased rates of death, but it’s really hard to tease out whether this is a low salt diet is bad, or sicker people eat less including less salt. Most of us in Western populations way too much salt, so some some reduction I salt would be healthy. Where is most of the salt in the western diet: in processed foods.
If people ate more veg, more fruit, a small amount of lean meat/poultry/fish, truly wholegrain foods (not supermarket “wholegrain”), a moderate amount of mainly low fat dairy, nuts and olive oil and minimal processed crap we’d be a hell of a lot healthier. Which is really what the basic aus dietary guidelines and new nutrition australia healthy food pyramid show. It just doesn’t make the headlines.
Sorry for the long comment. But it’s a complex issue.

Hi Bek, thanks for the comments. I realise that diets are your bread & butter, so to speak, so just a few comments off the top of my head, because I need to check a few things before I say anything else.

First ‘high saturated fat diets = high rates of heart disease’. French Paradox?

I feel there’s a difference between saying something is OK and saying something else is ‘protective’. No way do I eat plant-based oils (meaning a bottle of the stuff), because these are processed foods, subjected to high heat regimes. I prefer to get my plant fats from eating the actual plant itself, or its seeds. Thus, if I eat fat in my diet it will always be natural animal fat which is unprocessed (I may just not eat a lot of it).

You say that “there is some early stage evidence that saturated fats in fermented dairy (mainly yoghurt and cheese) are not as bad for us as saturated fats in animal foods”, but dairy is an animal food. Do you mean that the fermentation process somehow makes the fat less problematic?

I have a feeling that Dr Kendrick in his first book, says there is no connection between saturated fat intake and heart disease, but I would have to check that.

Hi again Bev. I know, the French paradox! The main association in the early days came from the seven nations study. It was an association study which showed that saturated fat was associated with serum total cholesterol levels (not much info on what type of cholesterol), which was then associated with heart disease. Unfortunately the French weren’t included in this study. Some reasons why the French paradox exists may be:
1. Actually their diet isn’t all that high in saturated fat, as even though they eat cheese and butter and meat, it’s relatively small portions therof.
2. They watch their weight, which also has a major relationship to heart disease.
3. Cheese and proper cultured butter are fermented.
4. The wine they drink is heart protective, cancelling out the bad effect of the sat fats (you can see how this one is popular).
5. They are relatively active, and exercise is protective.
At the end of the day all these are theories, and unless we do the study we will never know. These type of studies are very expensive and they almost never get research funding.

I think there is a difference between cold pressed olive oil (I.e. Minimally processed) and heat treated oils. The big frustration I have is the misinformation out there, like the farce of an email that talks about how margarine is the same as plastic. It starts with a reasonable premise, but ends will complete bollocks. But it convinces the layperson, and probably sells a lot of butter.

Re: fermented foods. There seems to be something about yoghurt and cheese that means they don’t increase the heart disease (athrogenic) causing LDL cholesterol as much as the same intake of saturated fat in milk or butter. Of course we don’t yet know if this translates to less heart disease rates. Again, big expensive study to run, and no one to fund it. There also is a theory that there are different types of LDL cholesterol and some are not as athrogenic as others. But again still early stage stuff.

Add this to the evidence around the role of inflammation in heart disease, the (relatively) new area of advanced glycated end products and their relationship to heart disease, and that is only the beginning. I think if anything it shows just how little we know about how the body works.

The other thing too is we eat food, not nutrients, and when we take something away from the diet we invariably replace it with something else. I have no problem with the blog land advice of reducing highly refined, sugar laden foods from the diet. But to infer that saturated fat is ok, even healthy, is going a step too fat in my reading of the literature. I’d much prefer that people were told to eat more veg. Given around 4% of Australia’s eat enough veg for good health, I think that is the place where nutrition advice could have the greatest benefit, but never gets mentioned.

Thanks again, Bek. Sure is complicated! Interesting that bit about fermented foods. I have no worries about using full cream milk…at 3.5% fat I don’t think that’s enough for me to worry about, but I do try to keep cheese consumption down because the fat content is so much higher.

So how much veg do you think we should eat for good health? I’m surprised at that 4% figure.

Yes, the 4% comes from the 1995 Australian National Nutrition Survey. Recommended intake of veg is MINIMUM 5 to 5.5 serves a day, depending on your age and gender. (Personally I think recommending .5 of a serve is just silly, but anyhoo.) A serve is 1 cup of raw/salad veg or .5 cup of cooked veg.
Amazingly the NNS was only repeated a couple of years ago, in 2012 if my memory serves me correctly. They haven’t released the main report yet, only a couple of summaries. Main point that sticks out to me is 30% of kilojoules comes from “discretionary foods” i.e. non core foods (fruit and veg, breads and cereals, protein foods, dairy foods) – biscuits, cakes, chips, chocolate, take aways, “snack foods” etc.
30%!!! It’s no wonder we have a chronic disease problem. The problem is not the dietary guidelines, the problem is that most people don’t follow them.
Ah well, keeps me in a job 🙂

Eating Paleo got me pregnant twice, in the 15 years we were trying to conceive. I lived on a traditional food pyramid diet recommended by dietitians to treat my type 1 diabetes, all the times in between.

So when I see medical specialists poo-pooing Paleo as a fad, I figure they don’t know what they’re talking about. It made me realise I do actually have a working reproductive system. Otherwise the specialists would have given me drugs to help with ovulation, or at worst IVF.

Eating Paleo, or massive medical intervention? Guess which one the specialists would have advised first?

I’ve been in the medical specialist realm for 26 years with diabetes. They mean extremely well, but most are blinded by the current research, and will never colour outside the lines. Yet the cranks I’ve met were able to use observation in their many patients, to recognise the standard practices weren’t working. In fact, in some cases they were actually counterproductive.

Sadly, those cranks often left to work in alternative medicine because they were never respected by their peers, in the standard system.

Still visit your doctor, but perhaps you can find a reputable Naturopath too. You’re allowed to have both to help, if that’s what you choose.

Thanks Chris, good post. I didn’t realise how long you’d been trying to conceive. You must have been absolutely over the moon when Peter came along. There’s no understanding in the medical profession about the type of diets (and lifestyles and behaviour patterns) humans have actually evolved to. Civilisation (as the only way to live) wins again! Phooey!